Outcome prediction in severe traumatic brain injury with transcranial Doppler ultrasonography

Objective:　ToinvestigatethevalueoftranscranialDoppler(TCD)ultrasonographyinevaluatingtheoutcomeofseveretraumaticbraininjuryandtocorrelatetheTCDvalueswithintracranialpressure(ICP)andcerebralperfusionpressure(CPP)monitoring.　　Methods:　AprospectivestudywasconductedtoevaluatethecontributionofTCDultrasonographytoneurologicaloutcomeinaseriesof96severetraumaticbraininjurypatients.ThequantitativevariablesofTCDultrasonographyincludedthemeanbloodflowvelocityofthemiddlecerebralartery(MCA)andpulsatilityindexwithinthefirst24hoursofadmission.TheICPandCPPvalueswerealsorecorded.Outcomein6monthspostinjurywasevaluatedusingtheGlasgowOutcomeScale(GOS4-5wasconsideredas“good”andGOS1-3as“poor”).　　Results:　ThemeanbloodflowvelocityoftheMCAwaslargerthan40cm/sin30(51%)patientswithgoodoutcomewhereasitwaslessthan40cm/sin27(73%)patientswithpooroutcome(P<0.025).ThemeanPIincasesofgoodoutcome(34patients,57%)waslowerthan1.5whereasinpooroutcome(30patients,83%)washigherthan1.5(P<0.001).ThecorrelationsofICPandCPPtopulsatilityindexwerestatisticallysignificant(P<0.01).　　Conclusions:　TCDultrasonographyisvalidinpredictingthepatientsoutcomeof6monthsandcorrelatessignificantlywithICPandCPPvalueswhenitisperformedinthefirst24hoursofseveretraumaticbraininjury.